Hugo Swire: The Minister will be well aware of the well regarded provision of keyhole surgery in the treatment of gastro-intestinal cancer, as performed by the Royal Devon and Exeter hospital. He will also be aware that in his NHS next stage review interim report, Lord Darzi states:
	"Localise where possible, centralise where necessary."
	Does the Minister not agree that it is quite unnecessary to move the provision of that treatment from Exeter to Plymouth, and will he hold urgent discussions with the Devon primary care trust to point out their error of its ways?

Ivan Lewis: It seems eminently sensible that when we set targets, we take account of practical issues such as the fact that patients sometimes fail to turn up and fail to co-operate with the clinicians and the health service. It would be nonsense to tell hard-working NHS professionals that they had failed to meet a target due to circumstances outside the control of either the trust or the professionals and clinicians involved. Think of the damage to morale that that would cause. The announcement made last week is entirely sensible, and it will not affect the fact that we will get waiting times down for audiology in every part of the country.

Andrew Lansley: Another thing that people did not find before 1997 was their local hospital's maternity services disappearing and being transferred 15 miles up the road, as has happened in Welwyn, which I visited on Saturday. People in Banbury, where I also visited, did not find their maternity services being transferred to the John Radcliffe hospital 10 years ago. Likewise with A and E services. Right across London, people might well wonder what kind of NHS they have when, after 10 years and three times the amount of money, they cannot visit their local hospital safely, because although it advertises that it has an A and E department, it does not have the necessary back-up to make it one.
	Lord Darzi, who is on— [ Interruption. ] The Minister of State, Department of Health, the right hon. Member for Bristol, South (Dawn Primarolo), mentions Tomlinson from a sedentary position—I have a quotation from when she opposed the Tomlinson report—yet she and her colleagues propose a reconfiguration in London that seems to be based on the proposition that A and E departments will be available in local hospitals that have high dependency level 2 care, not intensive care. However, the Academy of Medical Royal Colleges has said in terms that for an A and E service to be provided, it is essential that it should be backed up by level 3 intensive care. And these Ministers have the temerity to come to the House and tell us that the reconfigurations are locally determined and based on clinical criteria. They are not; they are being dictated by the Government.
	The latest evidence came out only last week, in the  Health Service Journal, that the Government are proposing to try to fix the NHS tariff, so that they can force specialist services into centralised, larger hospitals by undermining the viability of specialists in district general hospitals.

Edward Balls: I would not be so pessimistic. I was disappointed to discover that Opposition Members oppose the reforms in the Queen's Speech on raising the education-leaving age to 18 and the proposals for diplomas, but it is not too late. Later in my speech, I will urge them to change their minds and consider backing those reforms.
	In Britain today we need all young people to be in education or training until 18. That is why our Bill will establish new rights for young people to take up opportunities for education and training, and the support they need to take up those opportunities. It will also establish new responsibilities for young people, and a new partnership between schools and colleges, and between local government and employers, so that every young person will be in education or training until 18 from 2015. It is my aim to build a consensus in the country in the next few years on that proposal, even if we cannot manage that in this House.
	There are also serious and proper concerns about the legislation. There will be extensive opportunity for debate over the coming months as the Bill moves through each stage, but I wish to address three of those concerns now. First, let me make it clear from the very beginning that this is not a Bill to force young people to stay on at school or college full time until they are 18. I have heard many people refer to our plans as raising the school-leaving age, but we are not raising the school-leaving age; we are raising the education and training-leaving age.
	Not all young people will want to continue in school or college, so our proposal is for young people to continue their education and training in the way that makes best sense for them. That could mean full-time education at school or college; work-based learning, through an apprenticeship; or one day a week in part-time education or training, if they are employed, self-employed or volunteering for more than 20 hours. That means that we will expand the number of apprenticeships in the next few years. We have already doubled the number since 1997, and we will increase that number further by 90,000, to 240,000 a year by 2013.
	My right honourable Friend the Secretary of State for Innovation, Universities and Skills and I have agreed that we will legislate in the Bill to ensure that there is the proper statutory basis for apprenticeships for 16 to 19-year-olds. That will set the framework for an entitlement by 2013 to an apprenticeship place for every young person who wants to continue their learning on a work-based route and meets the entry requirements.
	With our Bill, all individuals will have a legal right to train to their first level 2 qualification. Up to the age of 25, young people will have the same legal right to train for their first level 3 qualification. But because my right hon. Friend and I recognise that it is not only young people who need to achieve their full potential, and because 70 per cent. of those who will make up the 2020 work force will be beyond the age of compulsory education, our Bill will also ensure that all adults have the right to access proper free provision for basic literacy, numeracy and first full level 2 courses. That will enable all low-skilled and unemployed adults to improve their skills and secure sustainable employment.

Edward Balls: It is important that apprenticeships lead to a qualification. I was talking about apprenticeships for 16 to 18 year-olds in England by 2013. Clearly, we can attempt to go further than that as we go up the age range over more years and for the whole UK. It is our determination to match the Leitch ambitions, but there is clearly a lot of work to be done over the next few years.
	Although we want to make sure that young people can combine education and training with work, it is also our view that no young person should be left out on the basis that education and training are not for them or that it is too hard to meet their needs. That is why the Bill is about both rights and responsibilities. Under our proposals, young people will receive advice and guidance. They will achieve enhanced educational support in the form of educational maintenance allowances and they will have a wide range of opportunities to take up opportunities in school, college, apprenticeship work with training or on a place on a pre-apprenticeship course or an entry-to-employment programme.
	If young people fail to take up these opportunities, however, there will from 2013 be a system of enforcement. It will be very much a last resort and, as now for young people aged under 16, it will be at the discretion of the local authority, but it is necessary. I make no apologies for saying again that it is necessary to strike the right balance between new rights and new responsibilities. Some will need extra help, but that does not mean that they should be exempt. We will apply the same approach for 17 and 18-year-old mums as we do for school-age mothers now. Of course, they are allowed time off from learning before and after giving birth; of course, local authorities exercise care and discretion in relation to enforcement; and, of course, teenage mothers will need the extra support for child care that we currently provide through programmes such as Care to Learn. However, they should not be excluded from the opportunities and nor should people with special educational needs or people in custody. They will also receive education and training up to the age of 18. When we say that everyone will participate, that is what we mean.

Kenneth Clarke: The Prime Minister has constantly let it be understood that he was far less committed than Tony Blair to all this reform of the health service. He regarded it as what we used to describe as the internal market, and thought that there was a limit to what the market could achieve. The Queen's Speech gives no clue about that. The Secretary of State is comparatively new, because we keep changing Secretaries of State for Health. His predecessor found herself, near the end, in a constant mist. She made little progress in reform and spent her entire time firefighting incident after incident and presiding over debacles such as the junior doctors appointments farce.
	Is the Secretary of State now committed to reform? He nodded and said yes earlier. He will have to reassure me that he does not mean that with his foot taken off the accelerator and a touch on the brake, just trying to keep out of trouble. The NHS will require more. In my opinion, the NHS has never needed reform to be implemented effectively more than it does at the moment.
	The background is a great financial crisis. I shall not go into the cause of the present crisis, but it finally came to a head with those ridiculous pay settlements and new contracts, which laid down levels of provision for payments that the NHS could not afford. That has produced a fantastic mess, with deficits all over the place. My NHS trust is allegedly "borrowing" almost £10 million, which it will have to repay with interest next year to get itself out of deficit. Primary care trusts with surpluses find that they are "lending" money to the NHS trust to get it out of trouble, so that those that are run well and have surpluses they thought they could use to redesign their services do not have the money at the moment. The growth in funding in the NHS will slow down. The days when everything was buried with money and a 7 per cent. real-terms increase each year could smooth out a lot of the problems are over, and so the need for properly implemented reform has never been greater. I do not quite see where we are going.
	I want to concentrate on the key and most difficult issue in reform towards the model that the Queen's Speech defined as a patient-led service. That is the euphemism for reform in the direction that I have described. The most difficult thing on the way is the purchasing, or so-called commissioning, of services. Patients should have a choice, and I agree with the Liberal spokesman on that. Actually, Liberal Democrats are wrong to dismiss the professionals. None of us has clinical expertise. The patient exercises choice with the advice of his family doctor, usually a GP, who should be in a position to satisfy that choice. I have no idea where we are getting to on commissioning. No subject in the service has surrounded me in more of a mist of incomprehensibility. When I was Secretary of State, I laid down the plans for GP fundholding, to which we were committed. By the time the new Government came to office, half of all GPs in the country were in fundholding practices. The system was becoming popular and the Government made a big mistake by scrapping it. There is no point in going back over that; but then they changed their mind, did not abolish the purchaser-provider divide and revived the scheme under the name of practice-based budgeting, which we are now meant to have.
	The Government corrected some of the errors that we made. I approve of the national tariff. I will not argue too much about whether practice-based budgeting is exactly the same thing as GP fundholding, but it is the same principle. We are to back to purchasing and commissioning. Most GPs share my hope that they will be given much more control over how taxpayers' money is used for their patients and much more ability to redesign their local services and improve them in directions that they can see are desirable.

Ian Taylor: Thank you, Mr. Deputy Speaker. I will of course obey your stricture, much as I would otherwise have been tempted to comment on matters that need further attention in the Queen's Speech, such as the encouragement of the move to nuclear power as part of our overall energy diversity. I will, however, refrain from going down that route.
	I want to focus today on the Government's education policies and, particularly, on the subject of science, which is mentioned in the amendment. Let me start by saying that some of the behaviour of the Secretary of State for Children, Schools and Families during the debate would not have gone down very well with schools. Indeed, he might have been faced with exclusion, even if he did not break any of the rules of debate in this House.
	There is no disagreement between the Conservatives and the Government on the need to encourage more participation. There is no desire to make a distinction between those who can succeed in academic life and those who struggle, and who would—as the right hon. Member for Oxford, East (Mr. Smith) wisely pointed out—perhaps be better off following an alternative career path, and therefore an alternative educational path. Furthermore, Conservative Members understand that there are real issues around trying to keep the attention of children, whatever they are studying. The other day, I discussed some of those issues with a police inspector in my constituency. The police are trying to work with schools to keep children in school and to improve children's behaviour, without which no effort by the Government or anyone else will make a significant difference to those who find it difficult to maintain attention.
	In the past 18 months, I have been preparing a submission to the shadow Cabinet on education and science. I have considered existing apprenticeship and training schemes and visited Network Rail's impressive training scheme in Gosport, which takes youngsters when they are 15 to 16-years-old. The first year of that course is residential, and it will train our future engineers for the railway system, which is commendable. In many cases, those children did not want to stay on at school, but they will obtain a structured education within that engineering apprenticeship.
	We must reach out and find more options. I do not believe that the Government are attempting to extend the school leaving age to 18, and I share their idea that we should try to find diverse ways of encouraging youngsters to engage in something that will ultimately benefit them and society, and I am sure that my hon. Friends do, too. However, there is an issue: my concern is that in that desire to be inclusive, we are misunderstanding the concept of "excellence". Of course, everybody should be excellent, but we should not set the barrier for excellence at the point at which everybody can be excellent. I hope that the Secretary of State for Health will take that point on board in answering the debate. It is, of course, easy to malign someone such as me for saying that we must ensure that we keep striving to improve the top level of attainment in this country, but I am not saying that we should forget those who cannot attain it. As I have a short amount of time to speak, however, I want to concentrate on my real concerns.
	I shall start with a controversial point. In his opening remarks, the Secretary of State for Children, Schools and Families said that Conservative Members are against a 50 per cent. target for university education. I want to rephrase that point: we would like 50 per cent. of young people to be able to go to university—we would like to see more and do not see why the target should be 50 per cent.—but the issue is what we mean by "university". If only 25 per cent. or less of those young people get a decent A-level, it is almost certain that the others will not be able to aspire to getting into our best universities. There are all sorts of ways in which we can try to help them—I will not repeat the speech made by the right hon. Member for Oxford, East (Mr. Smith)—but we cannot ignore the fact that we have a problem. Meanwhile, global competition is expanding, and our best youngsters are being induced to go not only to American universities, but to Australian universities, which is not good for the United Kingdom.
	There has been some criticism of our best universities for not widening their intake—in many cases, they have strived to do so, and many of them have schemes to work with schools that they have identified locally—but we must recognise that we need to improve the standards of entrance, even from today. There has been a decline not in the intelligence of 18-year-olds, but in the standard that they are asked to reach. In mathematics, for example, some of our top universities have to spend at least two terms, and possibly even the first year, bringing students up to the standard that used to be achieved by students when they entered university, and that example involves top-grade entry. That means that we have a problem in making sure that our best children are stretched.
	There is a bigger issue. As I said in an earlier intervention, if one considers the number of youngsters who are taking chemistry, physics and maths—in the past year, there has been some debate about the figure for maths, which may well be due to a blip—the situation is extremely worrying. Unless we change that, we will not encourage this country's youngsters, who will subsequently become employees, to obtain the necessary skills. Many of our companies already say that they are extremely concerned by that point.

Eric Illsley: Yes. That is an aspect that I am about to deal with. My constituency has the highest number of people in receipt of the education maintenance allowance, and that has gone a long way towards improving staying-on rates after the age of 16, so I am a big fan of EMA.
	As I was saying, there is a fear that increasing the staying-on age to 18 could increase the number of young people in my constituency who completely drop out of education. The question has to be asked whether the resources would be better spent earlier in the pupil's lifetime, or whether we should increase the resources spent earlier in an individual pupil's school year in order to prevent the drop-out rate.
	I was pleased to see the Government talk about one-to-one literacy classes and the idea of secondary school pupils having a tutor of studies. Experience in my constituency suggests that we need to address problems as they occur in primary and secondary schools rather than allow children to leave school at 16, drift away and be lost from the system. I recall talking with employers a few years ago and finding that they wanted to take children at 16 and provide them with training within the job that they offered—but they did not want to have to teach the kids how to read and write. They wanted children to leave school with the basics, so that they could take on the training aspects.
	Let me say a few words about further education funding issues resulting from the Government's moves in that regard. I'm particularly interested in the relationship between the post-16 agenda and the 14-to19 agenda. My question is about the future of the learning and skills councils. Are they still to provide post-16 funding? Is money going to local authorities intended to provide for the 14-to-19 agenda, and if so, will that detract from the money available to our FE colleges? My hon. Friend the Member for Wolverhampton, South-West (Rob Marris), who is no longer in his place, referred earlier to the funding gap between schools and colleges. It would be quite wrong to maintain or increase the gap, or just to allow it to continue. The colleges are worried that local authorities will take some of their funding for the provision of the 14-to-19 agenda.
	Another question to the Government—I understand that my right hon. Friend the Secretary of State for Health cannot respond to it, but I hope that someone else will pick it up and answer it—is about the relationship between the vocational and the 14-to-19 agenda. We heard the Secretary of State for Children, Schools and Families talk about diplomas, but will there be any opportunity to mix and match between the two? Can the academic cross over to the vocational and vice versa, or are we to have a dividing line between diplomas?
	As for the capital funding of Barnsley college, it, like many others, has undertaken a rebuilding programme at the behest of the LSC, which has required it to borrow large amounts of money. Next year the college is embarking on loans of some £10 million. Because of the LSC's delays in agreeing that funding, the rebuilding programme has been held up and almost jeopardised. The college had to agree a rebuilding programme in phases, the first of which was to allow a decanting of the buildings to be refurbished. That first phase almost fell through because of the delays, jeopardising the other phases in the programme. What is the future of the LSC, which has brought about those loans, not only at Barnsley college but at others? Colleges are worried that they might be left holding large mortgages or loans in an uncertain future, given the divisions of funding between the 14 to 19 set-up and the colleges.
	I repeat that Barnsley has one of the highest take-up rates for the education maintenance allowance, which has been a huge success. It has improved post-16 staying-on rates in my constituency, and I hope that it will continue to do so.
	Finally, I have a concern about the Sale of Student Loans Bill. Will the Government ensure that students repaying student loans are not placed in any worse situation than at present through the sale of that student debt?

Graham Stuart: It is a great privilege and pleasure to take part in this Queen's Speech debate—I am not sure whether I am using the right terminology—on health and education, which are the twin pillars of public services in this country and make such a contribution to our society. They have something in common in terms of the pattern that has been in place since the Government came to power. In both cases, the Government have put in vast amounts of increased expenditure. In cash terms, I think that they have doubled expenditure on education and trebled the expenditure on health. However, productivity has fallen and the hopes of Ministers and not least the rest of the country and those who pay taxes have not truly been delivered.
	We have not yet had a Secretary of State for Health or for Education in this Government who have been prepared to be as entirely honest with the House as they may be with others behind closed doors. Who could be more frustrated than the Ministers of this Government who have put in so many resources and seen so little in return? That is not to say to the Secretary of State for Health that there have not been improvements; of course, there have. There have been improvements in every decade since the second world war. That is certainly so of health and I hope also of education, but the improvements have been too little for the money spent.
	If we consider issues such as social mobility and the aspirations of many Labour Members and Conservative Members—although Labour Members are often too grudging to accept that we share similar aspirations—it appears that, at a time of record levels of spending, we could have seen a real change in the opportunities for those with the least in this country and that we could have tackled the sustained levels of disadvantage that for too long have been a feature of this country. In many countries of western Europe and, indeed, across the world, those problems have been tackled more effectively than they appear to have been here. The Government deserve congratulation on being prepared to will the means and to will the funding, but they have not been able to deliver the policy framework that would have delivered the change that we all hope for. Social mobility has not improved.
	I wish to touch on a comment made by the right hon. Member for Oxford, East (Mr. Smith) who, as I said in an intervention, was parroting the remarks of the Secretary of State for Children, Schools and Families that Conservative Members are somehow interested only in the few and not the many. I hope that any fair-minded member of the Labour party would accept that that is absolutely untrue. Because the issue is about willing the means as well as the ends, Labour Members must accept that the legislation going through the House over the past 10 years, when coupled with the funding, have not been enough to tackle disadvantage—be that health inequalities or inequalities of outcome in education. For Conservatives Members to take a differing view and to challenge the Government's record and new legislative programme is not a sign that we are uninterested in the outcomes that we all devoutly wish for. We challenge them because of a profound disagreement about how the outcomes could be delivered.
	That neatly brings me to the subject of the diplomas over which there was a rather angry exchange because the Secretary of State for Children, Schools and Families entirely misrepresented, I think deliberately—

Annette Brooke: I am pleased to be able to speak in this debate on health and education because I wish to raise specific issues relating to access to health services that are clearly pertinent to the proposed children and young persons Bill.
	The first issue is the provision of therapeutic services for all abused children, including children in care. I have tabled amendments to achieve that provision to a series of Bills, starting with the Bill that became the Sexual Offences Act 2003—sadly, unsuccessfully in all cases. I believe that such provision must be made for looked-after children if we are to make a real difference. As an ambassador for the National Society for the Prevention of Cruelty to Children, I agree with the call for comprehensive post-abuse therapeutic provision for children in care, children in custody, children in refuges and children exhibiting sexually harmful behaviour.
	Child abuse remains an unacceptably large problem in the UK. A study undertaken by the NSPCC in 2000 showed that 16 per cent. of children had experienced some form of sexual abuse, which may well have been by a parent or other relative. Other forms of abuse—physical and emotional, or neglect—can also have a traumatic impact on children. In 2006, the Department for Education and Skills said that of 60,000 children in care, 63 per cent. were in care because they had experienced some form of abuse or neglect. Of course, in reality the problems are likely to be much more widespread, because of unreported instances or reporting taking place many years after the abuse occurred.
	The long-term consequences of child sexual abuse include anxiety and depression, anger and guilt, difficulties functioning at school, poor self-image, and difficulties with personal relationships and parenting. Adults being treated for mental health problems often identify childhood abuse as an influence. Research shows that 25 to 40 per cent. of all alleged sexual abuse involves young perpetrators. The majority of those children and young people have been or are being sexually, physically or emotionally abused themselves. Therapy at an early stage could therefore help to reduce the scale of the problems over time by breaking the cycle.
	Therapy can transform children's lives, but provision is inadequate and patchy across the country. Resources to provide a comprehensive service will be a problem, but I want at least a commitment to a strategy to make such services fully available in time. Camila Batmanghelidjh, the founder of Kids Company, has recently pointed out that the amount of money spent on locking up young people, and the generation of more crime with consequent high reoffending rates, could be reduced dramatically if comprehensive therapeutic services were more widely available. The average cost per child of therapeutic counselling is £5,000; the cost of holding a young offender in custody for a year is £30,000 to £40,000. Surely it makes sense to invest in preventive action such as therapy.
	A related issue is funding for residential family therapy and family assessments. In an Adjournment debate earlier this year, my hon. Friend the Member for Richmond Park (Susan Kramer) raised the case of the Cassel residential treatment centre, which is the only NHS residential hospital for families in the UK. Its services comprise psychotherapy for the parent and child, as well as specialist nursing input. Families are referred when concerns are raised about a child's welfare. Most referrals arise from a child being the subject of care proceedings, which are, in turn, legally enforced by section 38(6) of the Children Act 1989.
	After a 2005 legal case involving Kent county council, which centred on a dispute over whether the council had a legal obligation to fund the treatment of a child at the centre, there are concerns that there is a legal requirement only to fund assessments rather than treatment. It now appears that instead of an attempt being made to treat the family and enable them to overcome problems and become successful, children are simply being removed from the home and put into foster care or adopted. Surely it would be cost-effective to provide preventive services to support families. We must do our best.

Sharon Hodgson: I am pleased to talk about education and health in our debate on the Gracious Speech. It seems to me—and, I am sure, to many other hon. Members—that it is a major step forward to ensure that we do all that we can to educate children about health. The Government have responded well to the challenges that we face in those areas. At the brand new Cardinal Hume Catholic school in Gateshead in my constituency, it is a joy to see teachers and pupils excited about their new learning environment and the facilities that are on offer to them. Oxclose school in Washington has been fully refurbished using money made available through the building schools for the future programme, and it is a lesson to all of us that we do not always have to knock something down and start again to make it better.
	I want to talk about two issues that can be clearly linked across health and education. The Government rightly note the need to tackle obesity, promote skills and change lifestyles. My constituency suffers from health inequalities, which must be reversed. Obesity rates, smoking rates, cancer rates and deaths from heart disease are all higher than average. Despite that, I remind hon. Members that it remains one of the most scenic and friendly places in which one could hope to live.
	To help reverse these health inequalities, I know how important it is that we go further still in delivering good quality school food. We hear tales of mums passing pizzas through the school gates, chip shops making record lunchtime profits, and some children causing a mess and a nuisance out on the streets. The solution that I propose is straightforward and simple—free, universal, locally sourced, hot school lunches, given to all pupils under the age of 16, coupled with a policy whereby pupils are not allowed off the school site at lunchtime—a lunchtime lock-in, so to speak.
	If the scheme is to work properly, packed lunches should be discouraged. A large number of parents send their children to school with a packed lunch, but unfortunately most lunch boxes are far from healthy. What parent would go to the hassle and cost of providing a packed lunch, healthy or otherwise, if they could have a free, healthy, hot school meal for their child? Sourcing food locally would not only cut food miles, but play a role in supporting the local economy. In addition, universal free school meals would remove any stigma that is often attached to claiming free school meals, usually because children would rather be with their friends having a packed lunch or out at the chippie.
	Some 250,000 children who are entitled to free school meals do not get them because they do not claim them. In my constituency hundreds of children lose out every day, despite the best efforts of my local councils to increase take-up. A universal free school meals policy has been working in Sweden, Finland and Honduras, delivering significant results. Closer to home, there are pilots in Scotland and north Tyneside. These pilots are possible in England because of the Education and Inspections Act 2006, which removed any statutory obligation on schools to charge for meals, so let us make the most of that change. Surely that is why it was made.
	That would, of course, have a cost implication, but the long-term benefits of boosting educational attainment, fighting child poverty and tackling health inequalities must begin to outweigh the cost. Estimates of the cost vary, and I have heard a figure of £2 billion. However, the House of Commons Library, which is highly respected and a credible source, has put the cost between £900 million and £1.1 billion. That includes the cost of providing more meals and restructuring current catering contracts, but savings would be made through economies of scale. That sum is not peanuts, but it is still only about 0.2 per cent. of Government spending. It is worth noting that the cost of obesity is conservatively estimated to be about £3.5 billion a year, and we know the old adage about a stitch in time. I am sure that that provides us with some food for thought, and I hope the Minister digests it well.
	The second issue that I wish to raise in the time allowed is closely related to education. I urge Ministers to train a dyslexia specialist in every school, who in turn will train all teachers to recognise the signs of dyslexia. I also propose that during their training all teachers are taught a compulsory special educational needs module, rather than SEN as an optional extra, as at present. As a parent with a severely dyslexic son, I know only too well the pressure and frustration faced by many other parents in the same situation. My son was eventually statemented, and with that comes not only the recognition that he needs extra help, but the extra funding to pay for it. We can give all dyslexic children across the country—even those without statements—the help that they need and save money at the same time.
	Dyslexia affects one in 10 people. That means there are around 1 million dyslexic children in our schools. They need extra help and support. All our brains work in different ways and we need to ensure that pupils with special educational needs are given special teaching, with teachers who are qualified and able to meet their needs. It has taken 10 years of government and we have come an awful long way. We could not have done it without listening to people and stakeholders. We must listen to the parents of dyslexic children.
	A recent survey of such parents carried out by the charity Xtraordinary People and the British Dyslexia Association says that nine out of 10 parents think the support that their children are receiving is ineffective, and seven out of 10 believe their children are being given support by staff who have no specialist training in dyslexia. I welcome the one-on-one tuition that is being given to children who are falling behind in school, but for dyslexic pupils what makes the biggest difference is the opportunity to spend time with a specially trained teacher.
	I shall give one quick example. Ben, a 12-year-old dyslexic pupil, had spent six years being helped by a learning support assistant, at a cost of £27,000, and he had shown little, if any, improvement. I know this example to be true because it is exactly the same as my son Joseph's. After only 20 hours working with a dyslexia specialist, Ben's reading and spelling age rose by two years—all that at a cost of only £600.
	I am proud to say that the Government are delivering nearly £1 billion in funding for personalised learning, but we must ensure that it is spent wisely and not wasted. I hope that the Minister will give sincere consideration to the points that I have made.

Brooks Newmark: The Prime Minister's first hundred days can be summed up with a modified form of an old wedding proverb: something old, little new, plenty borrowed, lots of blue. Lumping health and education into one day's debate after two ministerial statements is also something of a marriage of convenience for a Government who have failed to deliver on 10 years of empty promises on health care and education. However, it is less convenient for my constituents, most of whom regard the delivery of good health care and good education as the two most important ways in which Government policy affects their lives. I suspect that my constituents would be happier if there were fewer Bills in the Gracious Speech and more emphasis on the delivery of the services that matter to them.
	As ever, the Government are long on rhetoric and short on progress when it comes to the delivery of proper local health care. The Prime Minister now seems to have cast himself as Hercules cleaning out the NHS stables—or, more simply, as a cross between Flash Gordon and Mr. Muscle. But, as my right hon. Friend the Member for Witney (Mr. Cameron) exposed last week, his deep clean commitment has more than a whiff of spin about it.
	A further deep clean is now desperately needed: a deep clean of the Government's target culture and centralised control of health care. The Gracious Speech contained a commitment on behalf of the Government to
	"providing a healthcare system organised around the needs of the patient."—[ Official Report, House of Lords, 6 November 2007; Vol. 696, c. 1.]
	Yet the new health and social care Bill will introduce a new integrated regulator, more targets and more interference with front-line professionals—all, perversely, in the interests of boosting public confidence in a failing system.
	The sickness in the health service is borne out by my constituents' experience of obtaining adequate local health care. Before the 2005 election, they were promised a community hospital, but progress on that has since evaporated as surely as the Labour majority did in Braintree. I have repeatedly raised the fate of that project in Parliament, and I will continue to do so. The primary care trust's latest position is that a full business case for the Braintree community hospital scheme will not be ready until March next year.
	Those delays have already had real consequences for patient care locally. This afternoon, I hosted an event to celebrate the 25th anniversary of the Farleigh hospice, which provides support for my constituents and others across mid-Essex. Last year, Farleigh cared for 2,663 people, but its year has closed with the news that the day hospice must vacate its premises on the site of the former St. Michael's hospital in Braintree by the beginning of next year, because the future of the site and of the community hospital that was supposed to be built there is still uncertain. I do not see the Government's commitment to local health care anywhere in the vicious circle that has trapped Braintree's community hospital project since 2005. We have a Government whose unprecedented investment has been matched only by its unconscionable waste. Will the Secretary of State for Health now demonstrate a true commitment
	"to providing a healthcare system organised around the needs of the patient"—[ Official Report, House of Lords, 6 November 2007; Vol. 696, c. 1.]
	by committing to build a community hospital in Braintree?
	Unfortunately, the pace of change on education has left a lot to be desired. Some £1 billion has been invested in cutting truancy, but truancy rates have risen again recently with a hardcore of more than 200,000 children still regularly playing truant. The Government have failed to get to grips with keeping children in school until they are 16, but they now propose to keep children there until they are 18. I agree with the principle that improving skills among young people is both an economic and moral imperative. However, to think that greater participation can be achieved by the simple expedient of higher targets is at best naive, while to believe that either bribery or compulsion are the means to attain those targets is simply cynical.
	I also want to sound a brief note of caution about one of the core principles of the Leitch review of skills. Lord Leitch's exhortation was to
	"focus on economically valuable skills. Skill developments must provide real returns for individuals, employers and society."
	That is right as far as it goes, but it has its origins in the Thomas Gradgrind school of thought, being "eminently practical" but lacking in essential humanity. We must remember the moral imperative as well as the economic imperative.
	By way of simple example, I recently met my constituent, Mrs. Gina Fost, who is one of many people who are struggling to afford the cost of lip-reading and signing classes as a result of central Government meddling. Providers of adult community learning courses must follow guidance from the Learning and Skills Council. Residents in Braintree and Witham have seen their fees for lip-reading classes increase in the space of three or four years from nothing to £94 and finally this year to £186. The reason for those jumps is that the LSC does not view signing and lip-reading as "basic skills" worthy of full fee remission under the skills for life programme. Consequently, pensioners must pay 37.5 per cent. of the cost of the course themselves. To my way of thinking, however, there is no more important basic skill than the ability to communicate with others. The education and skills Bill will supposedly place new duties on the LSC to support free tuition for literacy and numeracy. If so, it ought to support free tuition for lip-reading and other basic skills, too.
	We need to reduce complexity in the funding system, not reinforce it. We need to move from a target-led approach to a demand-led approach to skills. In the drive for skills, we need to remember that support for some skills is governed more by a moral than an economic imperative. One of the Government's besetting sins in the past 10 years has been the unholy alliance between profligate legislation, prodigal spending and parsimonious delivery. This year's Gracious Speech is nothing different, which is why I shall vote against it and support our amendment.

Alan Johnson: The hon. Gentleman was not a Member of Parliament at the time. The explicit policy of the Conservative party in 2003 was to contract participation in higher education to 36 per cent. as a way to deal with the funding issue. The independent appeal panel in health was introduced by the previous Government, but the Conservatives now say that they would get rid of it.
	The subject of diplomas and the education Bills brings me to the hon. Member for Surrey Heath. My right hon. Friend the Secretary of State for Children, Schools and Families was absolutely right when he talked about the progressives and the modernisers on the Opposition Benches. I see the hon. Member for Havant (Mr. Willetts) in his place; he is certainly one of them, and we had high hopes that the hon. Member for Surrey Heath would be as well. However, one cannot be a progressive on education and oppose the introduction of diplomas and the increase in the education-leaving age. We had high hopes that the hon. Member for Tatton (Mr. Osborne) would prove to be a progressive when only a couple of years ago he stated, unambiguously, that the Conservative party—he was not speaking only for himself—supported not only our proposal on diplomas, but Tomlinson, lock, stock and barrel. An amazing change of policy has occurred in only a couple of years.
	The education-leaving age is the issue that will define education in the coming 20 or 30 years. Labour and the Conservatives have a shared ambition to raise participation to the highest possible level. Our ambition is to reach 90 per cent. participation by 2015. The Leitch report is saying that there are 3.2 million jobs that require no qualifications now, but there will be only 600,000 by 2020—the number of vacancies in our economy. We are expanding higher education. The hon. Member for Esher and Walton (Mr. Taylor) was wrong when he said that our policy is to get 50 per cent. of youngsters into university; in fact, it is to get 50 per cent. of 18 to 30-year-olds into higher education, a big chunk of which will be accounted for by vocational foundation degrees delivered in the workplace. My right hon. Friend the Secretary of State for Innovation, Universities and Skills is doing great work on following Leitch and increasing the number of people with level 4 qualifications.
	On the one hand, a youngster in this world gets the message that it is really important to get qualifications and make the best of their education; on the other hand, they are able to disappear off the radar screen at 16. First, that tends to make GCSEs a school-leaving certificate and the whole education system becomes geared towards a certain proportion of children leaving school at 16. Secondly, it gives mixed messages to youngsters who should be given the clear message that previous Governments gave—and not just the 1918 Government. God, the Liberal party were in power then; that shows how long ago it was. That Government looked to raise the school leaving age, eventually to 18. The great coalition Government of the second world war, with Rab Butler as Secretary of State, said that we should move from a leaving age of 14 to one of 15 immediately, and then to one of 16—that took too long—and said that we should then move to 18, either full or part time. The proposal is that when youngsters get to the age of 16, they either have offers of an apprenticeship, or undertake in-work accredited training, or take diplomas, which are crucial to the diversity of routes that they can take, and have the opportunity to stay on at school, too. All that is crucial to the future of education.

Alan Johnson: The Bill will ensure that every youngster who is properly qualified and wants to do an apprenticeship has the right to an apprenticeship place. It shifts the whole basis on which apprenticeships are offered.
	I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart), who is not in his place, on getting almost everything wrong in his contribution. Incidentally, in an intervention he said the most delightful thing. He asked whether the Secretary of State would agree that there is an epidemic in sexual health. I wish there were an epidemic in sexual health. That would be wonderful. However, I hasten to add that there is not an epidemic in sexual disease. The hon. Gentleman said that productivity in the health service has fallen. It has not. He said that social mobility was getting worse. It is not. There is a long time lag on that, but the latest statistics show that the social class gap has stopped widening, which is an important precursor to narrowing it.
	My hon. Friend the Member for Newcastle upon Tyne, North (Mr. Henderson) made a powerful speech and highlighted the importance of one-to-one tuition for youngsters from poorer backgrounds, as well as those from more prosperous backgrounds. It was an important contribution because raising the education-leaving age will not solve all the problems by itself. Introducing diplomas will not solve all the problems. The measures must be seen in the round, and must start with Sure Start for the youngest children and continue right the way through.
	The hon. Member for Mid-Dorset and North Poole (Annette Brooke) made an interesting contribution, particularly on the need for therapeutic assistance for children. My right hon. Friend the Secretary of State for Children, Schools and Families and I will work together on children's health on a Joint Committee to try and join services up in the way that the hon. Lady seeks. My hon. Friend the Member for Bury, North is a fellow member of the David Willetts appreciation society. The hon. Member for Havant was not in his place when my hon. Friend was eulogising his speech. I shall repeat it because I know that the hon. Member for Havant always likes to hear it. The hon. Gentleman said that selection does not spread advantage; it entrenches it. That is right, and my hon. Friend the Member for Bury, North was right to point that out.
	I wish I could mention all the interesting contributions from my hon. Friend the Member for Gateshead, East and Washington, West (Mrs. Hodgson), the hon. Member for Wyre Forest (Dr. Taylor), who is, as always, knowledgeable on these issues, my hon. Friend the Member for City of Durham (Dr. Blackman-Woods), the hon. Members for Enfield, Southgate (Mr. Burrowes) and for Braintree, and my hon. Friend the Member for Stourbridge (Lynda Waltho).
	Our vision is of health and education properly resourced, offering world-class services, with parents and patients fully empowered through voice and choice to have a real impact on quality. Ten years on, it is a vision that retains hope and aspiration. I commend the Gracious Speech to the House.
	 Amendment proposed, at the end of the Question, to add:
	"but regret the absence of measures in the Gracious Speech to empower professionals responsible for the delivery of health and education services and of measures which would make those services more accountable to patients and parents; deplore the absence of measures to improve public health and reduce health inequalities; regret the lack of a reformed legislative structure for the National Health Service which would reduce central targets and devolve decision-making closer to patients and enable health services to respond to the need for high quality and accessible care; further regret the lack of measures to deal with school discipline, raise standards in literacy, numeracy, science and languages, address under-performance in the primary sector, tackle disadvantage at its roots and provide effective support in the earliest years; and further regret the absence of measures which would deliver the real improvements needed in these and related public services." —[Mr.  Lansley .]

Question put forthwith, pursuant to Standing Order No. 33 (Calling of amendments at end of debate), That the amendment be made:—
	 The House divided: Ayes 211, Noes 311.